Popova I.E. 1, Kokov L.S.1,2, Kudryashova N.E. 1, Sharifullin F.A.1,2

Material and methods. A retrospective analysis of the computed tomography (CT), and magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) of 50 patients. According to the results of comprehensive clinical and instrumental assessments with the help of the TOAST classification, all patients were diagnosed with cryptogenic stroke. There were 27 men (54%) and 23 women (46%), mean age 60.5 ± 16.3 years.

Results. In the majority of 40 (80%) patients, the stroke was unilateral, and the right hemisphere was more often affected-31 (62%) cases. In 15 (30%) patients there was damage to the basal nuclei, in 10 (20%) patients infarction affected the cerebral cortex and underlying white matter, mainly in the SMA basin – 22 (44%), in 12 (24%) patients in the pool of perforating arteries of the M2 segment of the SMA (lenticulostriar branches), in the pool of terminal branches of the SMA - in 10 (20%) patients. CT of the brain showed no data for intracranial hemorrhage in all patients. During CT-AG and MRI-AG, the absence of steno-occlusive atherosclerotic lesions of the brachiocephalic and intracranial arteries was noted. During SPECT, the difference in rCBF values between the affected and unaffected brain segments (in vascular basins close to blood supply and drainage) ranged from 10 % to 17 % (with rCBF of unaffected segments of 41-42 ml/min per 100 g, rCBF of affected segments of 30-34 ml/min per 100 g). Based on the analysis done previously by other methods of examination, it was noted that the territorial coincidence of the hearth "excess" perfusion in SPECT with a plot of hyperperfusion in CT and plot athenaro edema according DWI MRI, allowing to judge about the "excessive" perfusion against the background of more extensive areas of hypoperfusion the ischemic brain.

Conclusion. Patients with cryptogenic stroke had right-sided damage to the basal nuclei and cerebral cortex, mainly in the middle cerebral artery basin. In the presence of an acute cerebral circulation disorder clinic, the absence of changes in CT indicates the presence of an ischemic stroke. MRI with DWI and brain SPECT are highly sensitive in detecting ischemia in the first hours of the disease. Brain SPECT is one of the most demonstrative methods for determining the localization and volume of impaired brain perfusion in patients with ischemic brain damage.

1 - N. V. Sklifosovsky Research Institute for Emergency Medicine of Moscow.

2 - I.M. Sechenov First Moscow State Medical University (Sechenov University). Moscow, Russia.

Keywords: magnetic resonance imaging, computed tomography, single-photon emission computed tomography, acute cerebrovascular accident, ischemic stroke of unknown etiology


Corresponding author:  Popova I.E., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript


For citation: Popova I.E., Kokov L.S., Kudryashova N.E., Sharifullin F.A. Radiological semiotics of the cryptogenic stroke. REJR 2021; 11(4):25-34. DOI: 10.21569/2222-7415-2021-11-4-25-34.

Received:        10.01.20 Accepted:       23.09.21